1. Randomized Trial Evaluating Clinical Impact of RAPid IDentification and Susceptibility Testing for Gram-negative Bacteremia: RAPIDS-GN
- Author
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Nicolynn C. Cole, Peggy C. Kohner, Sukantha Chandrasekaran, Sherry M. Ihde, Annabelle de St Maurice, Jennifer Curello, Michelle Earley, Nipunie S Rajapakse, William Swearingen, Abinash Virk, Katelyn A. Reed, Lauren Komarow, Lisa E. Hines, Robin Patel, Audrey N. Schuetz, Omai B. Garner, Brenda L. Dylla, Meganne Kanatani, Rubi Arias, Sarah B Doernberg, Judith J. Lok, and Ritu Banerjee
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,Randomization ,medicine.drug_class ,gram negative ,Clinical Trials and Supportive Activities ,Antibiotics ,Bacteremia ,bloodstream infection ,Microbial Sensitivity Tests ,Medical and Health Sciences ,Microbiology ,law.invention ,Vaccine Related ,Randomized controlled trial ,blood cultures ,Clinical Research ,law ,Interquartile range ,Sepsis ,Internal medicine ,Gram-Negative Bacteria ,medicine ,Gram-negative bacteremia ,Humans ,Blood culture ,Online Only Articles ,medicine.diagnostic_test ,business.industry ,Prevention ,Hematology ,Biological Sciences ,Anti-Bacterial Agents ,antibiotic susceptibility testing ,Clinical trial ,Emerging Infectious Diseases ,Good Health and Well Being ,Infectious Diseases ,Gram staining ,Blood Culture ,Antimicrobial Resistance ,Gram-Negative Bacterial Infections ,Infection ,business ,rapid diagnostic - Abstract
Background Rapid blood culture diagnostics are of unclear benefit for patients with gram-negative bacilli (GNB) bloodstream infections (BSIs). We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC) culture and antimicrobial susceptibility testing (AST) vs rapid organism identification (ID) and phenotypic AST using the Accelerate Pheno System (RAPID). Methods Patients with positive blood cultures with Gram stains showing GNB were randomized to SOC testing with antimicrobial stewardship (AS) review or RAPID with AS. The primary outcome was time to first antibiotic modification within 72 hours of randomization. Results Of 500 randomized patients, 448 were included (226 SOC, 222 RAPID). Mean (standard deviation) time to results was faster for RAPID than SOC for organism ID (2.7 [1.2] vs 11.7 [10.5] hours; P Conclusions Rapid organism ID and phenotypic AST led to faster changes in antibiotic therapy for gram-negative BSIs. Clinical Trials Registration NCT03218397.
- Published
- 2020